Provider Demographics
NPI:1568549285
Name:STUART, PETER JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9835
Mailing Address - Country:US
Mailing Address - Phone:802-334-4110
Mailing Address - Fax:802-334-4113
Practice Address - Street 1:81 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9835
Practice Address - Country:US
Practice Address - Phone:802-334-4110
Practice Address - Fax:802-334-4113
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009856207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2022Medicaid
VT8000224OtherLADIES FIRST
VT0572880001OtherDME
VT160044758OtherRAILROAD MEDICARE
NH30203331Medicaid
VT349689OtherMVP
VT00048005OtherBLUE SHIELD OF VERMONT
VTVN2022Medicare ID - Type Unspecified